Product Details

Brivlera

Brivaracetam
75 mg
Tablet


DIN/PIN/NPN

02452960

Manufacturer

UCB Canada Inc.

Formulary Listing Date

2018-12-21  

Unit Price

4.3200

Amount MOH Pays

4.3200

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

N03AX23

Interchangeable Products

NO  

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
548 Indefinite

-  As adjunctive therapy in the treatment of patients with partial-onset seizures (POS) who have had an inadequate response or have significant intolerance to at least 2 other less costly anticonvulsant therapies (prior or current use); AND

-  Patients are not receiving concurrent therapy with levetiracetam; AND

-  Patients are under the care of a physician experienced in the treatment of epilepsy.

Note: Less costly anticonvulsant therapies may include the following: 

Phenytoin, carbamazepine, gabapentin, lamotrigine, vigabatrin, topiramate, etc.

 

EAP Criteria

NO

Product Monograph

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